Outcomes of revisional treatment modalities in non-complicated Roux-en-Y gastric bypass patients with weight regain.

BACKGROUND: Laparoscopic Roux-en-Y gastric bypass (RYGB) is an effective treatment modality for severe obesity. Failure of weight loss and/or weight regain due to lack of restriction has been reported in long-term follow-up studies. The aim of this study is to determine the safety and effectiveness of reestablishing the restrictive component of the operation by trimming the pouch and/or anastomosis for pouch and/or anastomotic enlargement using a laparoscopic approach.

METHODS: We retrospectively reviewed our prospectively collected database for all patients that underwent revisional surgery of RYGB for weight regain or failure of weight loss. Percent excess weight loss (%EWL) and BMI loss (BMIL) were characterized into the following three time periods: (1) primary operation to pre-revision, (2) pre-revision to post-revision, and (3) primary operation to post-revision. Post-operative follow-up was at 6, 12, 18, 24, 36, and 48 months.

RESULTS: Between 2005 and 2011, a total of 121 patients in the database underwent revision of RYGB. Forty-four patients were identified that fulfilled the aforementioned parameters. In this group, 30 patients underwent trimming of the pouch and/or redo anastomosis (TPA), 8 TPA and conversion from retrocolic to antecolic Roux limb, and 6 TPA with remnant gastrectomy. Mean follow-up period was 26.1 ± 22.7 months. The post-revision mean %EWL was 38%, and the BMI loss was 7 kg/m(2). In the pre-revision to 48 months post-revision time period, mean %EWL and BMIL were 28.6% and 4.9 kg/m(2) in the TPA-only group, 52% and 8.8 kg/m(2) in the TPA with conversion to antecolic, antegastric group, and 33.4% and 5.9 kg/m(2) in the TPA with gastrectomy group, respectively (%EWL, p = 0.096; BMIL, p = 0.227). One patient (2.3%) developed a left upper quadrant hematoma. There was no mortality in this series.

CONCLUSIONS: Trimming of the pouch and/or anastomosis appears to be a safe and effective revisional modality for patients with insufficient weight loss or weight regain after gastric bypass in the hands of experienced surgeons.